SUCCESSFUL USE OF TERBUTALINE IN PERSISTENT PRIAPISM IN A 12-YEAR-OLD BOY WITH CHRONIC MYELOID LEUKEMIA

A 12-year-old boy had been suffering from intermittent episodes of penile erection for 2 weeks. For the last 2 days, however, the patient had been having sustained priapism and had to be admitted in a private hospital for management. Investigations revealed high total leukocyte counts. He was referred to the authors’ hospital where a diagnosis of chronic myeloid leukemia was made. He was started on intravenous hydration, hydroxyurea, and allopurinol. Imatinib was added 2 days later. The parents refused surgical intervention. Despite a reduction in the counts the priapism persisted and the pain was unresponsive to opioids. Administration of terbutaline was associated with a successful outcome resulting in relief from pain within 20 min. The priapism also resolved completely in 1 day.     

Single Nucleotide Polymorphism-Based Noninvasive Prenatal Testing: Experience in India

Introduction

Noninvasive prenatal testing (NIPT) has revolutionized prenatal screening for chromosomal aneuploidies in some countries. Its implementation has been sporadic in developing countries. Given the genetic variation of the people in different countries, we evaluated the performance of the SNP-based NIPT in India .

Materials and Methods

The Panorama? NIPT was performed in 516 pregnancies, which had tested intermediate-to-high risk on conventional first and second trimester screening. Results were confirmed either by invasive diagnostic testing or by clinical evaluation after birth.

Results

Of 511 samples analyzed, results were obtained in 499 (97.7%). Of these, 480 (98.2%) were low risk and 19 were high risk. A sensitivity of 100% was obtained for detection of trisomies 21, 18, 13 and sex chromosomal abnormalities. The specificity ranged from 99.3 to 100% for abnormalities tested. Taken together, the positive predictive value for trisomies 21, 18, 13 and monosomy X was 85.7%. The average fetal fraction was 8.2%, which is lower than the average observed elsewhere.

Conclusion

This is the first report of detailed experience with NIPT in India and demonstrates comparable performance in all aspects of testing to the results elsewhere.

     

The ZMF: Is it a reliable intraoperative guide for the IOF?

Intraoperative localization of the inferior orbital fissure (IOF) is necessary when making an osteotomy across the zygomatic bone while performing an orbito‐zygomatic craniotomy. The zygomatico‐facial foramen (ZMF) may serve as good reference point for locating the IOF. In this study, the position of the ZMF was assessed and its location in relation to the IOF was measured in 78 skulls. The ZMF was present in 83.3% of the skulls and when present, was related to the lateral end of the IOF in all cases. The mean distance of the ZMF from the IOF was 15.6 mm, and the mean distance between the ZMF and the fronto‐zygomatic suture was 25.9 mm. In skulls where the ZMF was absent, the mean distance of the inferior orbital rim (at the level of IOF) from the fronto‐zygomatic suture (20.7 mm) could be used for determining the position of the IOF. The IOF could thus be located ～15–16 mm medial to the ZMF in the same transverse plane. The location of the ZMF could also be used as a landmark for determining the inferior limit of the orbito‐zygomatic craniotomy. Clin. Anat. 22:451–455, 2009. © 2009 Wiley‐Liss, Inc.     

Leukemia Cutis: An Unusual Presentation

Leukemia cutis is the term used for cutaneous manifestations of leukemia, which can have varied clinical presentations. A skin biopsy can help in diagnosing such condition and differentiating it from other skin diseases. We present a case where a 45 years old man presented with diffuse papulovesicular skin lesions mimicking dessiminated herpes. Further workup revealed patient having acute myeloid leukemia (AML-M2) and skin biopsy showed infiltration by myeloblasts. With chemotherapy patient went into remission and skin lesions healed.     

Evaluation of orthodontic mini-implant placement: a CBCT study

Background

Optimal positioning of orthodontic mini-implants is essential for a successful treatment with skeletal anchorage. This study aims to compare the accuracy of two-dimensional radiographs with a cone beam computed tomography (CBCT) for mini-implant placement.

Methods

An ideal site for mini-implant placement at the buccal interradicular space between the second premolar and the first molar was determined for 40 sites (in 13 patients aged 14 to 28 years) by using CBCT data. The mini-implant placement procedure was then divided into two groups. In CBCT group, mini-implants were placed at the sites determined from CBCT data. In RVG group, mini-implants were placed with the help of two-dimensional digital radiographs and a custom made guide. Postplacement CBCT scans were obtained to determine the accuracy of the mini-implant placement. The results were statistically analyzed with a Mann-Whitney test.

Results

A statistically significant difference (p value = 0.02) was observed between the two groups for deviation from an ideal height of placement of the mini-implants. Deviations in mesiodistal positioning and angular deviation showed a statistically non-significant difference. Three out of twenty mini-implants in the RVG group showed root contact in the mandibular arch that may be attributed to the narrower interradicular space and reduced accessibility in the mandibular posterior region.

Conclusions

Although CBCT provides an accurate three-dimensional visualization of the interradicular space, the two-dimensional intraoral radiograph of the interradicular area provides sufficient information for mini-implant placement. Considering the amount of radiation exposure and cost with the two techniques, it is recommended to use two-dimensional radiographs with a surgical guide for a routine mini-implant placement.     

Does umbilical cord blood-derived CD34+ cell concentration depend on the weight and sex of a full-term infant?

Umbilical cord blood has recently been considered as an alternative source of hematopoietic progenitor cells for clinical application. Patient survival in allogenic cord blood transplantation is critically dependent on the cord blood-derived total nucleated cell count and the total CD34 cell count/kg of the body weight. A number of factors such as maternal age, gestational age, newborn's sex and weight, umbilical cord length, and placental weight can influence the volume, amount of mononuclear cells, and the CD34 cell concentration. Cord blood was collected from normal vaginal and cesarean deliveries. It was immediately processed and assessed for the total nucleated cell count and CD34 cell concentration. Assessment of maternal and neonatal parameters such as gestational age, baby's birth weight, and sex was carried out with the CD34 cell concentration. The mean CD34 cell concentration was 0.21±0.24% for the group with <2500 g (low birth weight) birth weight of the baby (n=104). The mean CD34 cell concentration was 1.84±1.12% for the group with ≥2500 g (normal birth weight) birth weight of the baby (n=396). A strong positive correlation was found between birth weight of the baby with cord blood-derived CD34 cell concentration (*P<0.0001, r=0.81). A positive correlation was found between gestational age and cord blood-derived CD34 cell concentration (*P<0.0001, r=0.31). No significant correlation was found between the baby's sex with the CD34 cell concentration and the total nucleated cell count. This study concludes that the higher the birth weight of the baby, the better the yield of the CD34 cell concentration, and hence these should be the preferred samples for infusion.